Provider Demographics
NPI:1700877156
Name:GOMEZ COLON, NIDZA T (MD)
Entity Type:Individual
Prefix:
First Name:NIDZA
Middle Name:T
Last Name:GOMEZ COLON
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1396 MEDICAL PAVILION
Mailing Address - Street 2:STE 11
Mailing Address - City:SANTUREE
Mailing Address - State:PR
Mailing Address - Zip Code:00909
Mailing Address - Country:US
Mailing Address - Phone:787-724-6590
Mailing Address - Fax:787-724-7280
Practice Address - Street 1:1396 MEDICAL PAVILION
Practice Address - Street 2:STE 11
Practice Address - City:SANTUREE
Practice Address - State:PR
Practice Address - Zip Code:00909
Practice Address - Country:US
Practice Address - Phone:787-724-6590
Practice Address - Fax:787-724-7280
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-03
Last Update Date:2010-08-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
PR6232207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PR0098407OtherPITAN
C84227Medicare UPIN